Rhinoplastry

What is rhinoplasty?

It is the surgery of the nose which involves correction of the septum and correction of external deformity to have the normal breathing and cosmetic pleasing nose.

I have heard that there are are open and closed method of rhinoplasty I want no scar and best result kindly guide me?

Yes there are two approaches of rhinoplasty exposure. One is closed approach in this the incision are given inside the nose but the exposure is limited. If we are doing open approach there will be a small columellar scar which is not visible but exposure to nasal anatomy is good . Now a person going for rhinoplasty who is concerned with result should not be bothered by the inconspicuous scar in the columella.

My skin is thick will my surgery have a satisfactory outcome.?

Definitely the overlying skin makes a difference in the result but planning is important so patient with thick skin are given extra care in augmentation as the result is depend on the height and fine work is not very visible and they require lot of cartilage. The result is satisfactory and nowadays we are giving isotretenoin to decrease the thickness of skin and results have definitely improved.

What type of anaesthesia will be given?

Ideally we prefer to give general anaesthesia as it is comfortable for the patient. It is very safe and is given by a board certified anaesthesiologist. The anaesthesia is given by I.V drugs and then patient is intubated . Once the surgery is finished the patient comes to conscious immediately
Sometimes we use local anaesthesia for tip work. In this we are using the local injection to block the nerves and sometimes we give iv sedation to comfort the patient.

How long will it take to get the result?

Once survey is done the result are immediate but next day swelling occurs and it takes about 2 months to have good result and the result will keep on improving for next 4 to 6 months

Will my breathing improve after rhinoplasty?

Yes breathing will definitely improve if you have problem before for in rhinoplasty we are correcting the septum as well as all the nasal valve so the breathing improve. Nowadays it is call nasal framework correction. Dr. Gambhir is trained in both the septal framework correction and nasal framework correction so the cosmetic and functional aspect of nose is corrected at the same time.

I have my surgery done earlier but not happy with the result when can I go for second surgery?

Normally we prefer that after one rhinoplasty procedure you should wait at least one year before the next surgery as result improve with time and also the tissue get softened so that they can be manipulated in better way. For revision rhinoplasty dr. Gambhir is best as his experience is very vast in this field.

What is the right age of rhinoplasty?

We prefer to do cosmetic rhinoplasty in female at age above 15yrs and in male above 16 yrs as the nose is in growing phase before then. In case the patient has severe functional breathing problem we can operate at 12 to 13 yrs of age.

Till what age I can get my rhinoplasty done?

Normally in younger age group it give good result but above 60years of age the healing is slow and cosmetic results are not good . These patient because of ageing skin may develop functional problem they definitely require rhinoplasty.

When I can resume my normal activity after rhinoplasty ?

Normally after full cosmetic rhinoplasty there is a small bandage over the nose and slight bruising under the eyes. This normal is there for 1 week so patient having desk job can go back to work after this and those who have physical activity will require additional 1 week. Strenuous exercises are to be avoided for at least 4 weeks.

PENILE ENLARGEMENT

Are there risks or potential side effects?

As with any surgery, there are risks, including an allergic reaction to the anaesthetic. Specifically, penis enlargement carries the following risks and side effects:

  • swelling, bruising and mild discomfort usually occur
    infection
  • sensation may be altered or completely lost
    function may be altered
  • erections may become more horizontal than vertical
  • delayed wound healing and/or poor scarring may occur
  • bleeding may occur and should blood collect (a hematoma), this may require further surgical treatment

Nicotine intake associated with smoking causes constriction of blood vessels. As a result of this constriction lesser blood flow to the damaged tissue occurs and chances of scarring increase. Smokers undergoing this surgery may actually lose a skin portion due to decreased oxygen flow within the skin because of nicotine. In turn, the decreased skin oxygen levels due to carbon monoxide may result in dead skin. However, these risks may be greatly reduced if the patient quit smoking before ( at least two weeks ahead) the surgery and does not resume the habit until healing process is complete.
With respect to the results of these procedures, there are no guarantees with respect to the final size and lengthening without a widening procedure may make the penis look thin. Penis shape cannot be assured with a widening process. The healing process takes time and the final result will not be readily visible for many months but sometimes, revisions may be necessary.

What to expect post-procedure?

You will wear a light pressure dressing for at least a few days and elevation is recommended as well as wearing jockey shorts. The penis and scrotum are usually swollen and bruised for two to three weeks. You will be sore in the groin and pubic regions for up to two weeks, but this can be controlled with medication. You will see the doctor two to three days after surgery. At this time, it is possible that you are able to shower or bathe and start your own wound care and shaft wrapping. Sutures are removed 7-10 days post-op.

Sometimes doctors may also suggest a routine of manual stretching for a week combined with a weight program. The post-surgery weight program includes hanging of weights and other traction methods from the penis to increase the length and maintain it. Lengthening procedure includes weight program to be followed for two weeks, three weeks in case of fat autografts, and four to five weeks for the procedures involving derma fat grafts or flaps. Some patients are able to maintain traction for up to six months post the surgical procedure. This helps in reducing the chances of retraction and stretching of the shaft skin. Maintain traction for longer period may also help in achieving further elongation due to stretching of the tissues that were not cut during the surgery. Scars after the surgery fade away and soften over a long period running into months.

How soon does normal life resume?

It is highly recommended that you take two weeks off minimum, and then slowly reintegrate yourself back to normal life. Avoid sexual intercourse and heavy sports and activities for at least 4-8 weeks.
Even after free-fat transfer, it is best to give the new cells at least 3-4 weeks to heal and early sexual activity might cause them to shift to an unwanted location.

Who performs it?

This procedure is normally performed by a plastic surgeon or a urologist.

Are you a good candidate?

As with any cosmetic surgery, it is important to have realistic expectations the outcome of the surgery – this is a prerequisite. If you feel that penile enlargement may be appropriate for you, make sure:

  • Your surgeon is aware of any and all medical conditions and any allergies you may have and. Also, tell your surgeon about any medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription).
  • You are not prone to scarring problems such as keloids.
  • You do not smoke.
  • You have a good understanding of the limitations of the procedure.

Smokers are advised to stop for two weeks prior and at least two months post surgery. Complete cessation is recommended as new research indicates that smokers heal very slowly.

How to prepare for surgery?

Many doctors will not perform the surgery without an evaluation by a either a psychiatrist or psychologist. Also, because smokers heal poorly, many doctors will not perform the surgery unless the patient quits smoking at least two months before the surgery. Your doctor will give you specific instructions to prepare for surgery but here are some general guidelines:

  • Avoid aspirin, any aspirin containing medication or any other non-steroidal anti-inflammatories (NSAID), such as Motrin or Advil, for two weeks prior to treatment. Because aspirin thins the blood, it can interfere with normal blood clotting and increase the risk of bleeding and bruising.
  • Intake of alcohol should be avoided for a few days prior to the surgery.
  • Ask for help from someone who would drive you home after the surgery and assist you for at least 24 hours.
  • Make sure that you arrange for someone to bring you home and to help you out for 24 hours after surgery.